536 CHAPTER 12
Prodromal phase
The phase that precedes the onset
of a psychological disorder (such as
schizophrenia) when symptoms do not
yet meet all the criteria for the disorder.
Active phase
The phase of a psychological disorder (such
as schizophrenia) in which the individual
exhibits symptoms that meet all the criteria
for the disorder.
marijuana more frequently and more recently actually performed better on various
neuropsychological tests, which suggests that marijuana use may enhance the cogni-
tive functioning of people with schizophrenia (Coulston et al., 2007). Results from
an fMRI study suggest that marijuana affects people with schizophrenia by increas-
ing the activity of the frontal lobe, which counteracts some of the cognitive defi cits
and impaired brain functioning that can accompany the disorder (Callicott et al.,
2003; Freedman, 2008).Course
Typically, schizophrenia develops in phases.In the premorbid phase, before symp-
toms develop, some people may display personality characteristics that later evolve
into negative symptoms. During the prodromal phase, which occurs before the on-
set of a psychological disorder, symptoms may develop gradually but do not meet
all the criteria for the disorder. In the active phase, a person has full-blown positive
and negative symptoms that meet all of the criteria for the disorder. Over time,
the individual may fully recover, may have intermittent episodes, or may develop
chronic symptoms that interfere with normal functioning.Premorbid Phase
In the premorbid phase, a person who later goes on to develop schizophrenia may
appear odd or eccentric and may have diffi culty interacting with other people
appropriately. This was the case for the Genain quads; during the premorbid phase,
the sisters, with the possible exception of Myra, were seen as odd, and lacked the
skills to make and sustain relationships with nonfamily members. However, it is
important to note that most people who are odd or have eccentric tendencies do not
develop schizophrenia. In addition, many people who develop schizophrenia, and
particularly those who develop schizoaffective disorder, did not have odd or eccen-
tric characteristics before the illness emerged.Prodromal Phase
The prodromal phase, which may last from months to years, is marked by signs of
suspiciousness, some disorganized thinking or behavior, poor hygiene, angry out-
bursts, and social withdrawal. These behaviors can be seen as precursors of the
symptoms of schizophrenia, but they have not reached the level of positive and neg-
ative symptoms necessary for a diagnosis of schizophrenia (Heinssen et al., 2001;
Maurer & Häfner, 1995).
The prodromal phase was a bit different for each Genain sister. Hester may
have begun her prodromal phase as early as age 11, when her cognitive function-
ing was suffi ciently impaired that she could no longer keep up in school and was
held back. Moreover, even in elementary school, she was described as socially inept
(Rosenthal, 1963; Mirsky et al., 2000). By 11th grade, her symptoms progressed to
the point that she could no longer function well enough to attend school. In spring
of that year, she was on her way to the active phase: “She complained of feeling
insecure, was temperamental, began making sighing noises, clicking her tongue,
and ‘hatefully’ combed her hair” (Rosenthal, 1963, p. 104). The tongue clicking
and sighing continued for months, and she became destructive, breaking things.
Instead of attending 12th grade, she stayed home, helping her mother around the
house. Hester dressed and fed herself, but she was very slow at these tasks and
would sometimes simply sit and stare into space.
In contrast, Nora’s prodromal symptoms emerged later. After high school, she
was employed as a stenography clerk in the same building as her father’s offi ce.
However, after 1 year of working there, she began to have crying spells and
increasing agitation. Her father criticized her for working too hard and told her to
quit her job. During the time she held the job, Nora successfully fought off an
attempted rape by a client of the company she worked for; her parents’ (and boss’s)
response was that she should keep quiet about it and go on as if nothing happened.
After that, she became increasingly agitated and disorganized until she quit her job
several months later. Her illness progressed to the active phase; she developed